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Laser Resurfacing

Surgery Overview

Laser resurfacing uses a
laser to send out brief pulses of high-energy light
that are absorbed by water and substances in the skin called chromophores. The
light is changed into heat energy, and the heat then destroys (vaporizes) thin
sections of skin, layer by layer. As the wounded area heals, new skin grows to
replace the damaged skin that was removed during the laser treatment. Some
lasers only tighten the skin by heating it but do not destroy the skin.

The CO2 (carbon dioxide) laser is the most common type of laser used for
resurfacing. Erbium lasers are also used frequently.

Laser resurfacing is usually very precise and causes little
damage to the surrounding skin and tissue. It is done most often on the face,
but it may be done on skin in other areas of the body. The hands, neck, and
chest may be avoided because skin in these areas does not heal as well as it
does in other areas. It tends to thicken and scar as a result of the laser
treatment. Some surgeons are willing to treat the neck using a lower-energy
laser.

Newer laser methods

Fractional laser skin resurfacing, which treats microscopic
columns of skin. The treated areas of the skin are surrounded by untreated
areas, which results in visible improvement without much bleeding or
scabbing.

Plasma skin resurfacing, which uses plasma energy to
destroy the lower layers of skin but does not affect the top layer of skin.
This top layer protects the lower layers of skin as they
heal.

Superficial erbium:YAG laser resurfacing, which is a mild
laser treatment method. This works best for minor wrinkles and other skin
problems.

Infrared laser resurfacing, which targets deeper layers
of the skin with heat to smooth and tighten the skin.

How it is done

The areas to be treated are cleaned
and marked with a pen. A
nerve block with a local anesthetic is usually used to numb the area
before treatment. You may also be given a sedative or antianxiety medicine to
help you relax. If your entire face is going to be treated, you may need
stronger anesthesia (in some cases,
general anesthesia), pain relievers, or sedation. You
may need to wear goggles to prevent eye damage by the laser. And wet towels
will be placed around the area to absorb excess laser pulses.

The
laser is passed over the skin, sending out pulses. Each pulse lasts less than a
millisecond. Between passes with the laser, the skin will be wiped with water
or a saline solution to cool the skin and remove tissue that the laser has
destroyed. The number of passes required depends on how large the area is and
what type of skin is being treated. Thin skin around the eyes, for instance,
requires very few passes with the laser. Thicker skin or skin with more severe
lesions requires a greater number of passes.

The pulses from the
laser may sting or burn slightly, or you may feel a snapping sensation against
your skin. Little or no bleeding occurs in most cases, although severely
damaged skin may bleed. When the treatment is finished, the area is covered
with a clean dressing or ointment.

What To Expect After Surgery

The time needed for healing and
recovery after laser resurfacing varies according to the size and depth of the
treated area. Someone who has the full face resurfaced, for example, will
have a longer recovery time than someone who has only a small area of skin
treated.

Typically, the wounded area will be pink, tender, and
swollen for at least several days. Cold packs and
nonsteroidal anti-inflammatory drugs (NSAIDs, such as
aspirin or ibuprofen) may help reduce swelling and pain. After skin regrowth
occurs, the skin will remain red for several weeks.

Proper care of
the treated area while the skin is healing is extremely important.

Rinse the skin several times a day with cool
tap water to avoid infection and to get rid of the crusting that sometimes
develops. Avoid soaps and perfumes.

Change the
ointment or dressing on the treated area to keep the area moist and promote
healing.

Avoid sun exposure and, after peeling has stopped,
use sunscreen every day. New skin is more susceptible to sun damage.

You may be given an antiviral drug called acyclovir to
prevent infection if you are receiving treatment around your mouth. Tell your doctor if you have had
cold sores in the past.

Several follow-up
visits to your doctor will be needed to monitor the skin's healing and regrowth
and to identify and treat early signs of infection or other
complications.

Why It Is Done

Laser resurfacing may be used to
improve the appearance of or remove:

Wrinkles.

Superficial scars caused
by acne, surgery, or trauma that are not growing or that are getting
thicker.

Color (pigment) changes or defects in the skin, such as
liver spots (lentigines), port-wine stains, or café-au-lait
spots.

People with lighter skin who do not get a lot of sun
exposure after the procedure tend to have the best results. People with darker
skin may benefit from laser resurfacing, but their skin may not heal as
well.

You may not be a good candidate for laser resurfacing if
you:

Have had skin color changes, scarring, or
thickened tissue (fibrosis) as a result of earlier treatment.

Have
a skin, blood flow, or immune disorder that could make healing more
difficult.

Have a history of abnormal scarring (keloid or
hypertrophic scars).

Are currently using isotretinoin (a drug used to treat acne) or have used it within the last 6 to 12
months. This increases the risk of scarring after the
procedure.

How Well It Works

Your skin type, the condition of
your skin, your doctor's level of experience, the type of laser used, and your
lifestyle following the procedure can all affect the short-term and long-term
results of laser resurfacing. Some types of skin problems or defects respond
better to laser resurfacing than others. People with lighter skin who limit
their sun exposure after the procedure tend to have better results than those
with darker skin and those who continue to spend lots of time in the sun.

In general, laser resurfacing tends to have good results with
fairly low risks.

Wrinkles caused by aging and long-term sun
exposure, such as those around the eyes and mouth, respond well to laser
resurfacing. The long-term results of laser treatment for these types of
wrinkles are unknown. Keep in mind that new wrinkles will probably appear as
your skin continues to age.

Wrinkles caused by repeated movement
and muscle use (such as those on the forehead or along the sides of the nose)
may be improved but not eliminated. They often come back months or years after
treatment because the muscles continue to perform the activities that caused
the wrinkles before treatment.

Mild or moderate acne scars may be
somewhat improved. Laser treatment is less effective on severe acne
scars.

The long-term results of laser treatment may not be evident
for several months.

Risks

Side effects and risks of laser resurfacing may
include:

Swelling, itching, crusting, and tenderness.
These are expected, temporary effects of laser resurfacing.

Redness
(erythema). Normally this lasts 6 to 12 weeks, but it may last up to 6 months
in some people. Some people may turn red or flush during stress or exertion
more easily than they used to, for up to a year.

Color (pigment)
changes in the skin. In 30% to 40% of people, especially those with darker skin
tones, the treated skin is darker than the surrounding skin.1 Bleaching or peeling of the skin can help lighten the skin
for a more uniform skin tone, and the skin may fade on its own over time. A
small number of people have a loss of color in the treated skin 6 to 12 months
after the procedure. This effect may be permanent, especially with deeper laser
treatments.

Skin irritation, including acne flare-ups in people who
are prone to acne.

Bacterial, viral, or fungal infection of the
skin. Infection may affect the rest of the body also.

Scarring
(rare). Scarring may be improved with medicine.

A condition in
which the edge of the eyelid rolls outward and exposes the inside of the eyelid
(ectropion). This is a rare but serious complication of laser treatment in the
eye area. Surgery is sometimes needed to correct it. It is more likely to occur
in people who have a loose lower eyelid or who have had surgery on their lower
eyelids (blepharoplasty).

What To Think About

Expectations

Laser resurfacing first injures or
wounds the skin and then destroys the top layers. You need to prepare yourself
for how your skin will look immediately after treatment and throughout the
healing process. It is also extremely important for you to follow your doctor's
instructions on caring for your skin after the treatment, so you can avoid
infection and help your skin heal.

Be sure that your doctor
understands what you hope to achieve and that you understand what results you
can realistically expect. Even with realistic expectations, you may not see
results for several weeks or months after laser resurfacing. You may need more
than one treatment to achieve the results you want.

Sun protection

After laser resurfacing, you will
need to wear sunscreen every day and avoid sun exposure as much as possible.
New skin is more susceptible to damage and discoloration from sunlight.

Options for resurfacing

Laser resurfacing,
chemical peel, and dermabrasion are the most commonly used techniques for
improving the texture and appearance of the skin. Although these techniques use
different methods, they have basically the same effect on the skin: they
destroy and remove the upper layers of skin to allow for skin regrowth.

No one technique is necessarily better than the others. When done by
an experienced surgeon, laser resurfacing may be slightly more precise than
chemical peels or dermabrasion. But the choice of technique is based on the
site you want to treat, your skin type and condition, the doctor's experience,
your preferences, and other things. Some people may get the best results by
using a combination of techniques.

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